Narrative identity, mental illness, and recovery: A systematic review across diagnoses

Abstract

Individuals across a range of mental illnesses struggle with identity problems. These problems are important to investigate because they may represent vulnerability to mental illness, emerge as consequences of psychopathology, and pose barriers to recovery. The narrative identity approach is especially suited to illuminate identity problems because it combines a first-person perspective with systematic quantitative studies and provides a strong theoretical foundation for recovery-oriented care. We present a pre-registered systematic review across diagnoses to examine 1) how mental illness is associated with narrative identity and 2) whether narrative identity is related to recovery. After screening 2,327 abstracts, we identified 75 relevant papers. The studies sampled individuals with a range of diagnoses and employed a multitude of narrative identity and recovery measures. Our synthesis suggests that across the examined mental illnesses, narrative identity is less coherent and with adversely affected meaning-making and self-event connections as well as more negatively emotionally toned with lower agency and lower communion themes. The evidence was most robust for schizophrenia, which was more often studied. Regarding relations between narrative identity and recovery, we could not detect consistent patterns, likely due to the complex pairing of multiple narrative identity and recovery measures combined with small sample sizes. Future research could examine a broader array of mental illnesses with respect to transdiagnostic and disorder-specific narrative identity problems and prioritize well-powered, prospective and carefully controlled studies to gain a deeper understanding of the sources of narrative identity problems and the predictive power of narrative identity in relation to recovery.